Pelvis Flashcards
the pelvic organs are _____peritoneal
infra peritoneal
why might the bladder be enlarged in older males
enlargement of the prostate can lead to problems emptying the bladder so it distends
which bone the bladder found in very close contact with
pubic bone
which surface of the bladder is covered in peritoneum
superior/posterior surface
what are the pouches formed by the peritoneum covering the pelvic organs
females
rectouterine pouch
vesicouterine pouch
males
rectovesical pouch
what is the urachus
embryological remnant
what type of epithelium lines the bladder
transitional epithelium
what is the name of the folds in the bladder lining
rugae
which structure can be seen surrounding the urethra in males and is assoicated with the underside of the bladder
prostate
what is the trigone
triangular base of the bladder
which region does the bladder enter when it fills with urine
suprapubic region
describe the internal surface of the trigone
area of smooth mucous membrane
which three openings make up the corners of the trigone
ureters entering the bladder
urethra leaving the bladder
describe the openings of the ureters into the bladder
why are they like this
small slit like openings that close over themselves
to prevent black flow of urine up the ureter to the kidney
what is the name of the muscle that makes up the bladder wall
detrusor muscle
what type of muscle is the detrusor muscle
smooth muscle
what is the name of the sphincter at the neck of the bladder
sphincter vesicae
what is the name of the urethral sphincter located in the urogenital triangle
sphincter urethrae
what is the difference between sphincter vesicae and sphincter urethrae
vesicae = smooth muscle (involuntary) urethrae = skeletal muscle (voluntary)
which ligaments old the neck of the bladder in place
puboprostatic (MALE)
pubovesical (FEMALE)
arterial supply to the bladder
2x superior vesical arteries
1x inferior vesical arteries
which arteries are the vesicle arteries branches of
internal iliac
what is the inferior vesical artery often known as in females
vaginal artery
where do the inferior vesical/vaginal arteries supply
inferior surface of bladder
venous drainage of the bladder
vesical plexus to internal iliac vein
autonomic innervation of bladder
inferior hypogastric plexus
lymph drainage of ureter
lumbar, common iliac and external iliac nodes
changes as the ureter descends towards the bladder
lymph drainage of bladder
main drainage to internal iliac nodes
superior to external iliac nodes
neck area to sacral nodes
lymph drainage of urethra
mainly to internal iliac nodes
male spongy urethra to deep inguinal
females to sacral nodes
describe how the rectum is covered in peritoneum as it descends
upper 1/3 covered by visceral peritoneum
middle 1/3 covered on anterior surface
lower 1/3 infra peritoneal
where does the rectum run from
approximately 3rd sacral vertebra to tip of coccyx
when does the rectum become the anal canal
as it passes through the pelvic floor
which structure creates folds in the internal surface of the rectum and what are the sacculations called
transverse folds creates ampulla
which structures in the rectum aid in faecal continence
voluntary sphincter in the anal triangle
involuntary sphincter the the walls of the the rectum
puborectalis muscle loops around rectum
how does puborectalis aid in maintenance of faecal continence
creates a sling around the rectum
creates a bend in the rectum so when the muscle relaxes the bend lessens the angle allowing passage through the rectum
arterial supply to the rectum
superior rectal artery = inferior mesenteric artery
middle rectal artery = internal iliac artery
inferior ectal artery = internal pudendal artery
venous drainage of the rectum
superior = portal system middle = internal iliac inferior = internal pudendal
lymph drainage of rectum
pararectal nodes to inferior mesenteric and internal iliac nodes
allows spread of disease in two directions
nerve supply to rectum
inferior hypogastric plexus
how can the uterus be identified in the pelvis
midline structure between the bladder and rectum that appears to communicate with both sides of the body wall laterally
what is the broad ligament made up of
double layer of peritoneum
what are the areas of the broad ligament
mesosalpinx = over Fallopian tube mesovarium = over ovaries mesometrium = over uterus
what structures are contained in the broad ligament
veins and arteries
whats supplied by the ovarian artery
top part of uterus, fungus, Fallopian tube and ovaries
what does the uterine artery supply
lower uterus
what does water under the bridge mean
uterine artery passes over the ureter
what are fimbriae
little fingers at the end of the fallopian tube
what are the main parts of the uterine tube
fimbriae
infundibulum
ampulla
isthmus
what does the round ligament provide
a potential pathway for lymph to the abdominal cavity
where does the majority of the support of the uterus come from
ligaments attaching to the cervix
NOT THE BROAD LIGAMENT
what ligaments provide support to the cervix
uterosacral (sacrocervical)
transverse cervical
pubocervical (pubovesical)
what position is the uterus normally in
anteverted and ante flexed
what does anterverted mean (related to uterus)
long axis of the uterus is bent forward on long axis of vagina
what does ante flexed mean (related to uterus)
long axis of uterus is bent forward at internal os with long axis of vagina
blood supply to the ovaries
gonadal arteries
arise from abdominal aorta L2
venous drainage of ovaries
left to left renal vein
right to IVC
nerve supply to ovaries
aortic plexus
what structures are found in the suspensory ligaments of ovaries
ovarian vessels
what does the vas deferens join with to form the ejaculatory duct
ducts from the seminal vesicles
where are the seminal vesicles located
superior to prostate
what do the seminal vesicles secrete
liquid component of seen
including fructose
where is the prostate located
inferior to bladder
what does the prostate secrete
proteolytic enzymes and acid phosphatase
which arteries supply the prostate
internal pudendal
middle rectal
inferior vesical
describe the venous drainage of the prostate
deep dorsal vein of penis
venous plexus
internal iliac vein
what ligament supports the prostate
Puboprostatic ligament
anterosuperior surface of prostate to internal surface of pubic bone
which muscle supports the prostate
and where does it arise from
levatore prostatae
anterior fibres of Levator ani
how does levatore prostatae support the prostate
fibres from each side descend the sides of the prostate and join together to form a sling of muscle
lymph drainage of testes
aortic nodes at root of testicular artery (L2)
lymph drainage of skin of penis and wall of scrotum
superficial inguinal nodes
borders of the anal triangle
between the ischial tuberosities and coccyx
where is the centre point of the perineum
midpoint between ischial tuberosities
what structure is located in the anal triangle
anal canal
what are the boundaries of the ischioanal fossa
walls: ischial tuberosity and rectum/anal canal
roof: levator ani
floor: skin
what are the contents of the ischioanal fossa
branches of the pudendal nerve, artery and vein
adipose tissue
when does the rectum become the anal canal
when it pierces the pelvic floor
where is the internal anal sphincter found
within the walls of the rectum as it passes through the pelvic floor
where is the external anal sphincter found
surrounding the anal canal inferior to the internal anal sphincter
what structures are associated with the anal columns
terminal radicles of the superior rectal vessels
anal sinus
which structures supports the external anal sphincter
perineal body anteriorly
anococcygeal ligament posteriorly
innervation of external anal sphincter
pudendal nerve (S2-4_ inferior rectal branch
what are the 3 parts of the external anal sphincter
deep
superficial
subcutaneous
what is the pectinate line
site of the anal membrane in foetus
where is the pectinate line
at level of deep part of external anal sphincter
what is the anocutaneous line
aka white line
transition to true skin
what is the relevance of pectinate line with respect to neuromuscular supply
separates visceral and parietal supply
describe neurovascular supply to the anal canal/rectum above the Pectineal line
VISCERAL
nerve: visceral motor (para/sypmathetic) and sensory
artery: from inferior mesenteric
vein: to portal system
lymph: to internal iliac nodes
describe the neuorvascular supply to the anal canal/rectum below the pectinate line
PARIETAL
nerve: somatic motor and sensory
artery: from internal iliac
vein: to caval system
lymph: to superficial inguinal
boundaries of the urogenital triangle
theoretical lines between the pubic symphysis and the ischial tuberosities
fatty fascia in the pelvic region
camper’s fascia
what is camper’s fascia continuous with in the pelvis
ischiorectal fascia
fascia of thigh
what is camper’s fascia replaced with in males in the scrotum
dartos muscle
what is the membranous fascia in the pelvis called
colles’ fascoa
continuous with Scarpa’s fascia of the abdomen
where does colles’ fascia attach and where does it extend
attaches to the posterior border of the urogenital diaphragm
extends into the labia/scrotum
what are the three layers of the urogenital diaphragm
superior layer of fascia
middle layer of muscle
inferior layer of fascia
describe the superior layer of fascia in the urogenital diaphragm
deepest layer
blends with the perineal body and membrane
describe the middle layer of the urogenital diaphragm
contains sphincter urethrae and deep transverse perineal muscles
sphincter urethrae is innervated by
pudendal nerve S2-4
sphincter urethrae is smooth/skeletal
skeletal muscle
describe the inferior layer of the urogenital diaphragm
superficial
aka perineal membrane
what is the inferior to the perineal membrane
superficial perineal pouch
the urogenital diaphragm is attached to the pubic bone
true of false
the layers fuse and leave a small gap at the pubic symphysis to allow passage of blood vessels
where the deep perineal pouch
between the fascial layers of the urogenital diaphragm
what structures are located in the deep perineal pouch
urethra sphincter urethrae deep transverse perineal muscles internal pudendal vessels vagina + dorsal nerves of clitoris membranous urethra, dorsal nerves of penis, bulbourethral glands and penile arteries
muscles in the superficial perineal pouch
ischiocavernosus
bulbospongiosus
superficial transverse perineal muscles
what structures are found in the superficial perineal pouch
muscles urethra vagina/clitoris or penis erectile tissue nerves and vessels
describe bulbospongiosus in males
covers the bulb and corpus spongiosum
innervation of bulbospongiosus
pudendal nerve
describe ischiocavernosus in males
extends from the ischium to corpus cavernosa (x2)
innervation of ischiocavernosus
pudendal nerve
how do the muscles associated with the erectile tissues aid in their function
contract to compress blood vessels and prevent blood leaving the tissue
deep transverse perineal muscles are present in males/females/both
males
describe bulbospongiosus in females
wraps around each side of the opening of the vagina (from bulb of vestibule)
describe ischiocavernosus in females
extends from ischium to erectile tissue anteriorly (x2)
which structures are extensions of the crura
corpus cavernosa
what structures does the bulb of the penis contribute to
corpus spongiosus
the female equivalent of the bulbourethral glands are located where
in the superficial pouch (superficial to the perineal membrane)
which structure runs through the corpus spongiosum
urethra
the corpus spongiosum ends in which structure
glans
which structures are contained in the corpus cavernosa
deep artery of penis
what is the perineal body
small fibrous structure at the posterior margin of the urogenital diaphragm
what is the function of the perineal body
muscle attachment
which structures attach to the perineal body
external anal sphincter
bulbospongiosus
superficial transverse perineal muscles
which penile vessels lie outwith the erectile tissue
dorsal and deep dorsal arteries
what are the 4 parts of the male urethra
pre-prostatic
prostatic
membranous
penile/spongy
describe the prostatic urethra
widest part
receives the ejaculatroy duct
describe the membranous urethra
narrowest part
passes through urogenital diaphragm
what are the two main muscles of the pelvic floor
levator ani
coccygeus
what are the two parts of levator ani
Pubococcygeus and iliococcygeus
origin of Pubococcygeus
posterior surface of pubic bone
insertion of Pubococcygeus
anococcygeal ligament
coccyx
perineal body
innervation of Pubococcygeus
nerve to levator ani (S4) pudendal nerve (S2-S4)
origin of iliococcygeus
tendinous arch of levator ani
insertion of iliococcygeus
anococcygeal ligament
coccyx
innervation of iliococcygeus
nerve to levator ani (S4)
origin of coccygeus
ischial spine
insertion of coccygeus
inferior end of sacrum
coccyx
innervation of coccygeus
direct branches from S4-S5
which aspect of the pelvic floor does is made up by coccygeus
posterior
what are the parts of Pubococcygeus
puboprostaticus/pubovaginalis
puborectalis
describe puboprostaticus/pubovaginalis
muscle fibres pass around the inferior part of the prostate/posterior wall of vagina
what is the other name for puboprostaticus
levator prostatae
describe puborectalis
muscle fibres pass behind rectum to form a muscular sling around anorectal junction
what is the function of puborectalis
contraction increases the angle and helps to maintain faecal continence
what is the main innervation of the pelvic floor
pudendal nerve (S2-S4)
nerve to levator ani (S4)
direct branches from S4-S5
origin of piriformis
anterior surface of sacrum
insertion of piriformis
greater trochanter of femur
which vessels can be identified by their position relative to piriformis
superior and inferior gluteal arteries
innervation of piriformis
nerve to piriformis (S1-S2)
origin of obturator internus
anterior surface of obturator membrane and bony boundaries of obturator foramen
insertion of obturator internus
medial surface of greater trochanter
innervation of obturator internus
nerve to obturator internus (L5-S1)
which foramen foes piriformis pass through to reach the greater trochanter
greater sciatic foramen
which foramen does obturator internus pass through to reach the greater trochanter
lesser sciatic foramen
what is the function of the thickened fascia over obturator internus
attachment of levator ani
were is the bifurcation of aorta
L4
branches of the common iliac arteries
external iliac
internal iliac
where do the common iliac divide
at the level of SI joint
branches of anterior division of internal iliac
umbilical superior vesical obturator middle rectal inferior gluteal inferior vesical/uterine internal pudendal
branches of posterior division of internal iliac
Iliolumbar
lateral sacral
superior gluteal
which artery is a branch of the umbilical artery
superior vesical
what is the function of the umbilical artery in utero
transports deoxygenated blood from the foetus to the placenta
what does the inferior vesical artery supply in males
inferior bladder
prostate
seminal vesicles
how does the uterine artery reach the uterus
in the cardinal ligament
which branches are given off the uterine artery
vaginal branches
describe the course of the internal pudendal artery
exits pelvis via greater sciatic foramen, wraps around the ischial spine and enters the perineum via the lesser sciatic foramen
which nerve accompanies the internal pudendal artery
pudendal nerve
what is the terminal branch of the anterior division of internal iliac
inferior gluteal
how does inferior gluteal artery leave the pelvis
via greater sciatic foramen
branches of the posterior trunk
Iliolumbar
lateral sacral
superior gluteal
what is the terminal branch of the posterior division of internal iliac
superior gluteal
